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VI. CONSENT FOR ECT A. General Principles Prior to the first ECT treatment, informed consent should be obtained from the patient, or the appropriate surrogate if it is determined that the patient lacks the capacity to consent. 2. Informed consent for ECT is given for a specified treatment course, (whether acute, or continuation/maintenence) and/or for a specific period of time. Consent may be withdrawn at any time, including between ECT treatments, by the individual providing consent. 3. Informed consent should be obtained by the patient's treating psychiatrist, or the ECT psychiatrist 4. Informed consent for ECT is a dynamic process which is not completed with the signing of the formal consent document, but continues throughout the ECT course. The consentor should be informed of substantial alterations in the treatment procedure (including a perceived need for an unusually large number of treatments, and any other factors having a major effect upon risk/benefit considerations). Significant discussions with the consentor regarding these issues should be documented in the medical record. B. Characteristics of Informed Consent I . An informed consent is obtained willingly from the consentor, without threats PILGRIM PSYCHIATRIC CENTER Issue Date: 10/1/97 Revision Date: 2/20/2001 Facility Policy Reviewed Date:2/20/2001 Page 11 of 58 Issuing Office: Clinical Services Subject: ELECTROCONVULSIVE THERAPY (ECT) or improper inducements. It is obtained after providing adequate information about the procedure to the consentor, in an understandable form and language. This information includes the reason that ECT is indicated, the risks/ benefits of the treatment, a description of the the ECT procedure, a description of the general likelihood, severity, and management of the risks associated with ECT, and the expected results of the treatment. The consentor has the opportunity to ask questions. 3. At PPC, this information is conveyed in a written informed consent document, which is reviewed with the consentor, and supplemented with patient specific information presented orally by the Treating or ECT Psychiatrist. The consentor will be given a copy of the document to keep. The use of additional supplementary information in written, audio or video format is encouraged. C. Freguency of Obtaining Consent 1. Acute Course of ECT: Informed consent will be valid for a course of ECT up to 25 treatments, or 3 months (whichever is reached sooner). If more than 25 ECT treatments or more than 3 months are needed to complete a single course, then the clinical rationale for the continued ECT will be documented, and consent will be re-obtained. 2. Continuation/Maintenance ECT: Informed consent must be obtained prior to the start of the course of continuation/maintenance ECT and will be valid for 6 months. Consent must be reobtained if continuation/maintenance ECT is to be continued past the initial 6 month period. 3. Short Stay ECT: :Informed consent must be obtained prior the start of the first short stay ECT treatment, and is valid for 6 months. 4. Except for patients receiveing continuation/maintenance ECT, resumption of ECT after a gap of more than 14 days will be considered a new course of ECT and informed consent will be reobtained. D. Capacity for Consent 1. Capacity to provide consent for ECT is operationally defined as being PILGRIM PSYCHIATRIC CENTER Issue Date: 10/1/97 Revision Date: 2/20/2001 Facility Policy Reviewed Date:2/20/2001 Page 12 of 58 Issuing Office: Clinical Services Supject: ELECTROCONVULSIVE THERAPY (ECT) able: a. to comprehend the nature and seriousness of the illness for which treatment is being offered b. to understand the information provided concerning this treatment modality c. to form a rational response based upon this information 2. Patients are generally considered to have capacity to consent for ECT. However, all PPC patients MUST be evaluated in regard to their capacity, and this must be documented in the medical record. The presence of psychosis, irrational thinking, or involuntary hospitalization does not constitute proof of lack of capacity. A previous determination that a patient lacks the capacity to consent for other medical/surgical procedures, does not automatically extend to cover ECT, nor does it preclude the possibility of the patient having the capacity to consent for ECT. 3. The determination of capacity to consent should be made by the patient's treating psychiatrist. a. In the event of refusal to provide consent or withdrawal of consent for ECT, the treating psychiatrist or the ECT psychiatrist should inform the consentor of anticipated effects of this action upon clinical course and treatment planning. E. Patients Having Capacity to Provide Consent F. In this case, ECT should only be administered in the presence of voluntary patient agreement, including signing of a formal consent document. The patient has the right, upon his or her request, to have a person of his/her choice present when consent is sought. In cases when a patient withholds consent, ECT will not be administered. The hospital will not apply for a court order to administer ECT. G. Patients Lacking the Capacity to Provide Consent 1. If the patient is found to lack the capacity to give informed consent by the treating psychiatrist and the Associate Medical Director, authorization for the procedure must be obtained from the spouse, parents, an adult child, or a court of competent jurisdiction. 2. ECT may be provided to a person upon the informed consent of a surrogate acting on his or her behalf, unless the person to be treated objects to the administration of ECT. PILGRIM PSYCHIATRIC CENTER Issue Date: 10/1/97 Revision Date: 2/20/2001 Facility Policy Reviewed Date:2/20/2001 Page 13 of 58 Issuing Office: Clinical Servic es Subject: ELECTROCONVULSIVE THERAPY (ECT) |
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